Podcast Episode 46 | Building Trusted Doctor-Patient Relationships

with Shelly O’Donovan

About the Prosperous Doc® Podcast

The Prosperous Doc® podcast by Spaugh Dameron Tenny highlights real-life stories from doctors and dentist to encourage and inspire listeners through discussions of professional successes and failures in addition to personal stories and financial wellness advice.

Shane Tenny, CFP® is our podcast host and Partner at SDT. He has lectured numerous times for hospitals and physician groups and, most importantly, helped hundreds of clients develop strategies to navigate through turbulent times toward their financial goals.

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These discussions are explicitly tailored to doctors and dentists, highlighting achievements to inspire you to reach personal, professional, and financial wellness. You will hear real-life stories of doctors’ winding career paths to turning practice wealth into personal wealth. 

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Full Transcript

Shelly O’Donovan: 00:00 If a doctor, a physician, can take time to sit down face to face with that patient, even just for a couple seconds, that's going to make a big difference in opening up that trust.

Intro: 00:12 From Spaugh Dameron Tenny, it's the Prosperous Doc podcast. Real stories, real inspiration, real growth, a show for doctors who are ready to improve their overall wellness in every aspect of life. Now here's your host, Shane Tenny.

Shane Tenny: 00:27 All right. Welcome back to the Prosperous Doc podcast. My name is Shane Tenny and glad to have you with us today. And it occurs to me that in the midst of all of the training that is required to be a physician or dentist, there are few skills as critical as communication. And we have all heard the statistics on the balance of verbal and nonverbal communication to influence our message. We've all learned it firsthand over the year of COVID and working from home and the surge in telemedicine.

Shane Tenny: 01:05 Today, I'm going to use my verbal communication and this medium of a podcast to talk about doctor, patient communication with Shelly O'Donovan. Shelly has spent her career using communication to connect and influence and engage people authentically. She's worked in government relations in healthcare, both at the University of Pennsylvania health system and at GlaxoSmithKline. Shelly teaches persuasive speaking at the Wharton School. She's led an advocacy program for GSK, worked as a healthcare lobbyist, and now is the CEO of Authentic Influence Group. Her research shows that fostering better doctor, patient communication and workplace communication in general can have a really significant impact on those relationships, and ultimately what the patient receives. I'm excited about the topic. And Shelly, thanks so much for being here with me.

Shelly O'Donovan: 02:02 Thank you. Thanks for having me today.

Shane Tenny: 02:04 Yeah. There's so much I know we're going to go through related to communication. It's a deep well. Give us a little bit about yourself. How'd you get in this field to begin with?

Shelly O’Donovan: 02:15 Yeah. You explained my background perfectly. I've spent a lot of time in politics and in government affairs and trying to really influence what happens, and in all of these places I started to really notice how people communicated and I started to see patterns. There were patterns about who could communicate effectively, who could get the policies through that they needed to, who could move up the corporate ladder. So I just started to really be interested in what those patterns were and started to do some research on my own in the background, eventually got trained in nonverbal communication by a behavioral research lab, and so spent a lot of time just digging into those nonverbal behaviors and saw firsthand how that can really open up a room when someone has those behaviors and is using those versus somebody who's completely ignoring that nonverbal communication.

Shane Tenny: 03:09 I guess that brings me to one of the first questions I have on this topic as someone who loves communication myself and certainly rely on it for my livelihood and for this podcast, is communication something that can be taught and learned, or is it an innate skill that you're just kind of born with?

Shelly O’Donovan: 03:29 Yeah, it's actually a little bit of both. We definitely see that they've done studies where they take athletes, and so they've taken blind athletes and they do the pride behavior, their hands up overhead when they win the race, never having seen anyone do that. So there is some innate nonverbal communication that's there, but we can also learn it. Once you start to learn it consciously, know that you might need to be more open in your communication, it just really skyrockets how you communicate with people. So it's a little bit of both.

Shane Tenny: 04:09 And so even introverts can be good communicators?

Shelly O’Donovan: 04:11 Absolutely. What's really interesting is that introverts just need to tweak things a little bit and once they start to tweak that, in some instances they can be some of the best presenters we have, they can be some of the most thoughtful people in meetings. It just takes a little bit of practice.

Shane Tenny: 04:29 So how does this translate for the folks listening here are serving patients, they're wearing white coats, they're at the front lines of our healthcare system. Sometimes from talking with doctors and dentists around the country, there's this balancing act between their role as an expert and knowing information that just needs to be understood and then learning how to deliver it, kind of the old bedside manner. So why is this good doctor, patient communication important?

Shelly O’Donovan: 04:59 It's really important because patients really pick up on this. There have been studies in which they've looked at that patient, doctor relationship and they've asked patients after having an engagement with a physician, how did that feel? How did that go? Patients will come forward and say that they didn't feel like the doctor was listening to them, and a lot of times it's because of those nonverbal. It's because that physician is rushed, they only have a few minutes, and they're kind of onto the next thing so they're not taking the time to really look the patient in the face and connect with them in a meaningful way.

Shane Tenny: 05:36 When you say nonverbals, what does that mean? Because I'm thinking offhand of the Italian and my hands are moving, there's a lot of energy in that. It's more than that.

Shelly O’Donovan: 05:47 It is.

Shane Tenny: 05:47 Talk a little bit about what you mean.

Shelly O’Donovan: 05:49 When I say nonverbal communication, the three areas that I mainly focus on are suggestors, so that is the hand movement. And we have seen research where hands are really important in building trust. So if you put your hands under the table and talk to somebody the whole interaction, that's going to be a problem in building that trust. So that's the gesture piece. Also, facial expressions. So anything that your face is doing, any kind of interesting movements or micro-expressions that you're making. And then the final thing is ornaments. So whatever you're wearing, that's kind of a nonverbal cue as well. So that white jacket that that physician puts on, that is a nonverbal cue. And then the final piece, which sometimes is categorized as nonverbal, sometimes not, is voice tone. So we talk a lot about that in my company about voice tone and how important it is, because people can hear things in your voice. They can hear if you're stressed or rushed during the day and they pick up on that.

Shane Tenny: 06:48 So how does a practitioner engaging with a patient, how does their engagement impact the patient's engagement or understanding or satisfaction or trust, all of those?

Shelly O’Donovan: 07:03 There are many ways. So if the physician walks in and really takes a moment to look at the patient, make some eye contact, be open, also be front-facing. There's a study that [inaudible 00:07:16] did in which he looked at how people sit and when we see somebody head on like you and I are, that person is seen as more trustworthy. They're more open-minded. So if a doctor, a physician, can take time to sit down face-to-face with that patient, even just for a couple seconds, that's going to make a big difference in opening up that trust.

Shane Tenny: 07:39 You know, as you're describing this, it totally makes sense, and I can totally empathize with the trends in medicine over the last 10 years with electronic medical records, where you have to come in, you say hi, and then I immediately have to turn my attention to the computer screen and start documenting everything we're talking about.

Shelly O’Donovan: 08:00 Right.

Shane Tenny: 08:00 On the one hand, I want to build trust, on the other hand, I also need to code this correctly.

Shelly O’Donovan: 08:04 Right. And that's a real challenge for physicians because they have to do that business piece, but they still need to be able to layer in that face to face, that contact. So to the extent that you can come in and at least make that really quick, straightforward hello and engage the patient, and then even just calling out, say, "Hey, I have to do the paperwork here," so that the patient knows, okay, now it's time that the physician has to put this stuff in the system.

Shane Tenny: 08:37 So how do you go about... Communication is such an art.

Shelly O’Donovan: 08:38 It is.

Shane Tenny: 08:39 How do you research communication?

Shelly O’Donovan: 08:41 Yeah. So I have been doing a lot of research myself digging into studies. As you can imagine, it's a lot of behavioral research. So they will go in and take physicians and they will, in the physician space anyway, and they'll take physicians and participants and they go through these big studies.

Shelly O’Donovan: 09:00 Just to give you one example, which I think would be really interesting for your listeners. They did a study on voice tone and they were really interested in voice tone, so they took doctors speaking to their patients and took short clips. They kind of garbled the words on those clips so they could just hear the voice tone. And then they asked participants to rank those physicians in terms of likability and who they felt they trusted. Then they actually took malpractice rankings for these physicians and they lined up perfectly, meaning that if the physician was likable by the voice tone, then they were less likely to have malpractice suits against them. So a super controversial study, has not been replicated again, but it hints on this idea that voice tone and how much we like someone, how much we feel trust with them, can make a huge difference for physicians in this particular instance.

Shane Tenny: 09:58 Interesting. So to your point there, you're taking these study patterns, or I guess I'm not in the research field so I don't know what the right term, but where you're creating a scenario and then we're going to measure people's response or behavior to it as opposed to a randomized sample out of the public or something in this case.

Shelly O’Donovan: 10:18 Yeah.

Shane Tenny: 10:19 The nonverbal volume, tone, rhythm, however else you categorize speech directly connotes, even without knowing what the content of the dialogue was, I get an impression of whether I believe them, like them, trust them, etc.

Shelly O’Donovan: 10:33 Absolutely. And so to that point, the other thing is we build our first impression of someone within 20 seconds of seeing them. So it actually has nothing to do with hearing them speak, but 20 seconds of seeing someone. So they took... In that particular study, what they did was they took folks that were interviewing for a job and they filmed them interviewing, and then they took participants and showed the participants videos and said, "Okay, who would you hire?" And both those that saw 20 seconds and those that saw 20 minutes got the same results, and so it shows us that that first impression is quick. So you can imagine if you have a new patient that you have to really make that first day count with that new patient and really connect with them right off the bat.

Shane Tenny: 11:22 In the research and the work that you've done, is there either research or just your own thoughts around the balance between talking and asking?

Shelly O’Donovan: 11:31 You mean talking and asking questions?

Shane Tenny: 11:32 Yeah.

Shelly O’Donovan: 11:33 Yeah. I don't actually know of any research in particular for physicians around that. But the big thing is building trust and so trying to get the right answers from your patients, and in terms of the right answers, I mean whatever the real true answer is. So you always want to look for nonverbal behaviors that match what they're saying. If you have a patient and you say, "Does your leg hurt?" and they shake their head no, but they're saying yes, then that's an incongruency and so you want to continue to ask questions. That's a perfect place to continue those questions because something didn't match up and you need to figure out why. Because I think that often patients want to give the physicians the answers they want to hear. They want to be well, so they might fib a little bit about how well they are.

Shane Tenny: 12:28 It's such a fascinating topic and you can see where it's so critical but also such a challenge, particularly for physicians whose industry is under so much pressure between the number of patients to see, the EMR that has to be completed, all of that, the regulatory or bureaucratic things that have to be completed, as opposed to folks in dentistry that often have a lot more autonomy and independence and control over their schedule, their work style, that sort of thing.

Shelly O’Donovan: 13:01 Yeah, absolutely, and that's where the rubber really meets the road, because I think in the medical professional space, you really have to build that trust quickly. So making sure that you have open body language, that you're looking at them, making eye contact, all of those things have to happen really quickly in that meeting.

Shane Tenny: 13:19 Do you think... we've got to take a break in just a second here, but offhand, what do you think are perhaps some of the biggest tells or the things to watch out for that a doc listening to this might accidentally be doing when he walks in to see a patient in clinic or something like that and not being aware of?

Shelly O’Donovan: 13:36 Yeah. The biggest thing is just paying attention to the patient. I often find that physicians aren't... They're too busy doing other things or thinking about the work that they have to do and they miss the tells from the patient. Somebody crossing their arms, that's like a blocking move, so that means I'm kind of uncomfortable so I may be uncomfortable with the question you just asked me, I could be uncomfortable with you for some reason. Those kinds of things come forward, and if a physician can grab that and see that, then they can ask more questions, try to open that person up.

Shane Tenny: 14:12 Gotcha. Well, I've got a number of more questions. We're going to take a quick break and be right back.

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Shane Tenny: 15:50 I'm here with Shelly O'Donovan, CEO of Authentic Influence Group. We're talking about doctor, patient communication. Shelly, I'm thinking that some of our communication is with patients or with clients or people who are in our office to engage with us, some of our communication is with colleagues to present an idea. What's the difference between those types of communication or what's required? Or is there no difference?

Shelly O’Donovan: 16:18 Some of the things are similar. You always want to be exhibiting good body language tactics, but obviously you're going to have different issues with colleagues. You may know them better, so you may actually be more comfortable with them. You may have days where things aren't going well at the office, and so there may be some of that nonverbal rub that's happening. They may be giving you some angry micro-expressions or something because a project's not going well. So you're going to get a broader amount of tells to really look for with your colleagues.

Shane Tenny: 16:54 Just based on your familiarity with them, the length of time that maybe you have to interact, things like that. You were saying right before the break, you gave the example of crossing your arms. Whether it's me, the provider, crossing my arms and sending kind of a closed signal or the patient crosses his arms, are there other tells that come to your mind that would indicate somebody's not receiving your message very well?

Shelly O’Donovan: 17:17 Yeah, absolutely. It could be somebody just like looking down the whole time and not really listening to you, it could be someone who's kind of focused off on something else. Now, sometimes that can be just that person and how they interact with the world, so you have to be careful about that. And that's the one caveat with patients. I know that you don't have a lot of time with them so it's sometimes hard. Normally we say to try to baseline somebody to see what's in their normal day to day nonverbal, which you would be able to do with your colleagues, but that's really impossible to do in such a short time. So you have to look for things that stand out.

Shelly O’Donovan: 17:56 But any kind of blocking behavior, like if you ask them something and they put their hand up to their forehead, that's shame. So there's something there. If you were asking a question and that hand goes up, maybe you're asking them how many drinks per week and they put their hand up, maybe they're not telling you the truth then. Then you may have to ask more questions to get a little bit more information.

Shane Tenny: 18:18 What about if you sense that someone, maybe in this case a colleague, but what do you if you sense somebody is frustrated?

Shelly O’Donovan: 18:27 Again, just trying to build more rapport with them and trying to tone that down a little bit. If it's a colleague, you might be... We talked about face to face and how that builds trust, but sometimes in a tense situation, being across from one another can be a little bit adversarial. So in a negotiation or if you're talking about work hours or something that's going to be a little bit more... going to make somebody a little bit more angry, then you might just pull back a little bit in your body language so you're not so head on to them. You might just pitch out a little bit.

Shane Tenny: 19:02 I know, as I shared in the intro, we know that since COVID that there's been an exponential growth in telemedicine, in phone visits. I was talking with a hospital executive a couple of months ago. He said, "You know, in about four weeks of COVID, we were able to accomplish with telemedicine what we've been trying to do for four years." And a lot more patients were required to use that to see their physician, and therefore, now a lot of people are more comfortable with it or more willing to adopt it. How does interacting through the screen... Have you seen any studies on that? Do you know of resources taking place there?

Shelly O’Donovan: 19:42 Yeah. I don't know any that are particular to physicians, but I do know there've been loads of studies related to business. Some of the tips I have there are just, again, to focus on the person on the screen. You want to try to focus on the camera itself so that it looks like you're looking at the patient. Obviously if you're looking at a sore wrist or something, that's going to steer how you communicate too.

Shelly O’Donovan: 20:10 But the other thing is just making sure that the lighting is good so that you look like you're engaged, like you're awake, and all of those things, that becomes really important as well. And then just being again, face on with that person. I've seen too many meetings where someone has a screen off to the side and so they ended up the whole time kind of sideways, and I don't know with physicians if they're literally putting information in on another computer, they might end up doing that too. So it becomes really important to have that face-to-face, that eye contact, that direct interaction even on a video.

Shane Tenny: 20:47 Yeah, those are all great points now that you say them. I'm thinking of a visit my son had with his pediatrician last month, I think he failed all three of the points you made, which is look at the camera, not at the screen. If you're looking at the screen, it looks to the other person like you're looking down or sleeping. And then he was sitting in front of his window or his sliding glass door so all the light was behind him so he looked just silhouetted out like a protected witness, that sort of thing. And then to your point, when you look to the side, even if you're looking at, in this case, I presume he was looking at my son's chart, but you don't know that. You just know they're not looking at you. Again, there's nothing you can do because you're relying on the visit and that sort of thing, but it certainly doesn't feel as engaging as what it could be. I think many of us have had to become part-time news anchors over the last year, learning how to navigate the Zoom world.

Shane Tenny: 21:47 Are there trends that you see? I mean, you've been in this field for a long time and have been involved in research, either in business in general or in medicine.

Shelly O’Donovan: 21:57 I think that the big question right now is just what's going to happen if the world opens up again. And I think that there's some hesitation about how people engage and whether people shake hands or not. I will tell you that a handshake is worth three hours of face-to-face time, so as we think about whether we shake somebody's hand in the business environment or when your physician is walking in a meeting with a patient, that is a really great way to connect with someone, and so I hope personally that it's something that sticks around. Whether it does or not, I don't know. It'll be interesting to see.

Shane Tenny: 22:35 If a handshake is worth three hours, how much is a fist bump worth?

Shelly O’Donovan: 22:39 Yeah, I don't know. Well that I haven't seen a study on. There is one on the handshake.

Shane Tenny: 22:43 Now as we get ready to wrap up, I want to just ask what about our electronic communication? Our texting, our emails. So much of what happens goes through those channels where there is no nonverbal.

Shelly O’Donovan: 22:58 Yes, and so you have to be so careful with that. You have to think about am I using the right channel, am I communicating the right way? Shane, if you call me, you pick up the phone tomorrow and call me, then most likely you want a phone call back from me. So that's a good way to guide how you communicate. But the rules have changed a little bit and we've certainly seen people ignoring email even more and kind of moving to texting. But I always say, just think about that the person is getting that email or that text from you at 3:00 in the morning with a splitting headache and would they be receptive to it? That's one way to think of it and try to keep it concise, to the point, but positive as well.

Shane Tenny: 23:44 You're referring to the overall tone of whatever you're sending. Be empathetic to their state of mind. Do you have any guidance from your research and teaching on deciding which medium to use? When should I text somebody versus when should I email them?

Shelly O’Donovan: 23:59 Yeah. So the first thing, like I said, is just if somebody communicates to you in one way, it's best to go back the same channel. The other thing is it depends a little bit what it is. The longer a conversation, that is really going to need a conversation. But there's also this idea lately that I would have to reach out to you and actually schedule that to happen because people aren't just picking up the phone as easily as they would. Emails are great for things that need to be followed up on, but again, you might have to reach back out to the person because we find that people aren't reading their emails as much as they did a few years ago. And then texting is kind of more urgent, sometimes more casual.

Shane Tenny: 24:41 Or in the case of my mother, hopefully one sentence or less is what I'm trying to teach her. [crosstalk 00:24:49]. Well, thank you for your time and expertise. Definitely a complicated topic, one that takes skill and practice and effort, but an important one now more than ever as communication in some ways gets more complicated. It's more accessible.

Shelly O’Donovan: 25:07 Yes.

Shane Tenny: 25:08 And it's more complicated all at the same time. Shelly, thanks so much for being with us today and for your expertise.

Shelly O’Donovan: 25:15 Thank you. Thanks for having me.

Shane Tenny: 25:16 Thank you for joining us for this episode of the Prosperous Doc podcast. We've got another episode queued up coming out two weeks from today. Subscribe and you'll learn about it first. I'd also be remiss if I don't think Rob Ingle over at Law Pods for his help producing and editing the podcast. Also, thanks to Joanna Long, our podcast director for her help finding awesome guests like Shelly O'Donovan. And thanks to you for being here. We'll see you back here next time.

Outro: 25:46 This episode of The Prosperous Doc podcast is over, but you're not alone on your journey. Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years. To connect with us, visit sdtplanning.com today and take your financial wellness to new levels. Join us on the next episode of The Prosperous Doc podcast.